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40LID' <br />Alcohol & Gambling Enforcement <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota Street, Suite 1600, St. Paul, MN 55101 <br />651-201-7507 TTY 651-282-6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization Date of organization Tax exempt number <br />Monrovia College Alumni Association In the Americas, INC. October 19, 2001 0100862869 <br />Organization Address (No PO Boxes) City State Zip Code <br />61 Stewart Ave Delran New Jersey Delran <br />Name of person making anolication <br />Arving Smith <br />Business phone Home phone <br />6127034800 <br />Date(s) of event Type of organization ❑ Microdistillery 0 Small Brewer <br />08/02/2024 - 08/03/2024 0 Club ❑X Charitable ❑ Religious Other non-profit <br />Organization officer's name City State Zip Code <br />ERNESTJALLAH LEVITTOWN Pennsylvania 19057 <br />Organization officer's name <br />City <br />State <br />Zip Code <br />Joshua N Ping, lr <br />O RCESTCR <br />Massachusetts <br />01605 <br />Organization officer's name <br />City <br />State <br />Zip Code <br />NIKKI A ROBERTS-APEADU <br />�DELRAN <br />New Jersey <br />08075 <br />Location where permit will be used. If an outdoor area, describe. <br />Mounds View Community Center, Mounds View MN 55112 <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />TheEventHelper.com <br />PO Box 1549, Grass Valley, CA 95945 <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />TheEventHelper.com Amt. $1,000,000.00 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City of Mounds View <br />City or County approving the license <br />$120.00 <br />Fee An <br />Event in conjunction with a community festival [_J Yes FX] No <br />13,111 <br />Current population of city <br />Nyle Zikmund, City Administrator_ <br />Please Print Name of City Clerk or County Official <br />June 24, 2024 <br />Date Approve <br />August 2 and 3, 2024 <br />Permit Date <br />barb.benesch@moundsviewmn.org <br />City or County E-mail Address <br />Signature City Clerk or County Official <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event <br />No Temp Applications faxed or mailed. Only emailed. <br />ONE SUBMISSION PER EMAIL APPLICATION ONLY. <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY <br />PERMIT APPROVALS WILL BE SENT BACK VIA EMAIL. E-MAIL THEAPPLICATION SIGNED BY <br />CITY/COUNTY TO AGE. TEMPORARYAPPLICA TIONPSTA TE.MN. US <br />